Valve Clinic Tour: Beyond The #1 Ranking, Cleveland Clinic Places Patients First
By Adam Pick on April 26, 2012
Yesterday, I was incredibly fortunate to visit the Cleveland Clinic. While there, I met several cardiac surgeons, cardiologists, nurses, quality teams and administrators during a tour of the six-story Heart & Vascular Institute, commonly referred to as ‘HVI’.
I have to tell you… I wasn’t just impressed. I was very,very, very, very, very, very impressed.
Going into the visit, I knew that Cleveland Clinic was ranked #1 for cardiology and heart surgery by U.S. News and World Report for the past 17 years. I also knew that many members of our community raved about their patient experiences at Cleveland Clinic. However, I did not personally know what made HVI so unique. Now, as I write this on the plane ride home, I am starting to understand why Cleveland Clinic is so different, so reputable and so focused on valve surgery. During the tour, I identified 7 highlights about the Cleveland Clinic that I jotted down below.
Highlight #1 – The ‘Patient First’ Culture
For the past 35 years, Dr. Delos ‘Toby’ Cosgrove, the President and CEO of Cleveland Clinic, and Dr. Bruce Lytle, Chairman of the Heart & Vascular Institute, have worked to empower the Cleveland Clinic, its employees and, most importantly, its patients. Together, these two men have adhered to and built upon the founders’ core beliefs of medical cooperation, research and education. So you know, Dr. George Crile founded the Cleveland Clinic in 1921.
In addition to being incredible physicians, it is evident that Dr. Cosgrove and Dr. Lytle are extraordinary managers. They have injected a global and systemic ‘Patient First’ approach to care deep within the cultural DNA of the 30,000 employees that power the Cleveland Clinic. For example…
- Each employee at the Cleveland Clinic wears a badge that says, “Caregiver”
- Almost every employee I spoke with during the tour reminded me, “Our patients come first.”
- Several signs and billboards in HVI — even in an underground kitchen — declare, “Patients First”
- Live music and art exhibits fill a fun ‘Calendar of Events’ for patients
- Patients can enjoy yoga, reiki and massage therapy during their stay
- Each patient room is private
During my career as a high-tech consultant, I have spent time at many leading corporations including Philips, Siemens, Sony, Motorola, IBM and Sony. I believe these multi-national corporations could learn from Dr. Cosgrove, Dr. Lytle and Cleveland Clinic’s management team. I have never been exposed to a team so focused, so consistent and so articulate about their mission.
Highlight #2 – Experience, Experience & More Heart Valve Surgery Experience
When it comes to experience, the Cleveland Clinic performed 4,346 cardiac surgery procedures during 2010. Of those procedures, 67%, or 2,912 operations, involved some type of valve therapy. That said, Cleveland Clinic surgeons perform significantly more heart valve surgery than most of their peers. (So you know, the average number of mitral valve repair surgeries performed by cardiac surgeons is five per year.)
“The benefits of an experienced team are really important for patients,” shared Betsy Stovsky, Manager of the Health Resource Center. “Everybody hopes for a successful and uneventful surgery. However, when complications occur – and unfortunately they do – that is when you want an experienced surgical team that has handled those complications not once but many times before.”
To support its commitment to heart valve therapy, the Cleveland Clinic maintains:
- 13 cardiac surgeons
- 100 cardiologists
- Over 1,000 nurses
- 13 operating rooms (capabilities include robotic and percutaneous procedures)
- 298 private rooms
- 110 intensive care unit beds
Right about now, you might be wondering, “Is there a major epidemic of heart valve disease in Ohio?” or “Why is there so much cardiac surgery in Cleveland?”
During my tour, I learned that 50% of patients are not from Ohio. They are from other states and other countries. Several patients in our community – Anita Devine, Jeff Pirofsky and Linda Dixon — are part of this statistic as they traveled from New York, Alabama and South Carolina to Cleveland for valve surgery. Here is more about traveling to the Cleveland Clinic for heart surgery.
Highlight #3 – Quality and Surgical Outcomes
As you have seen in prior interviews with Dr. Gaudiani and Dr. Ennker, we actively encourage patients and their caregivers to request the surgical outcomes of their potential hospitals and prospective surgeons. To this point, Cleveland Clinic publishes their valve surgery outcomes at their website.
Within this report, you might find the following facts interesting:
- Isolated mitral valve repair hospital mortality was 0% in 2010, well below the 1.3% national STS benchmark (shown below)
- Isolated aortic valve replacement hospital mortality was 1.1% in 2010, below the 2.7% national STS benchmark
As for complacency among the Cleveland Clinic team, I did not detect it. Michelle Edwards, Data Registry Manager, shared with me, “We always strive to improve our outcomes and out internal metrics… We want to get better.”
To their credit, it should also be noted that more than 50% of Cleveland Clinic’s open heart cases do not fit into common categories within the STS database. These cases are highly complex, have more risk and often involve re-operations. “It’s interesting Adam,” Dr. Bruce Lytle, Chairman of the Heart & Vascular Institute, shared with me, “Many of our patients have been told that there is no treatment available to them. Second opinions for these high-risk patients need to be considered. Often, not always, there is something that can be done.”
Highlight #4 – The Heart & Vascular Institute Is Calming
It was right around eleven o’clock in the morning that I started to realize something very dislocating. I started to wonder, “Is this really a hospital?”
I could not believe how calming, how open and how peaceful the hospital felt. Although I forgot to ask, my gut tells me a Feng Shui master was integral to the design of this sizable but comfortable space. A beautiful fountain greets you at the entrance. Soft music plays in the background. Several pieces of art adorn the walls and hang from the ceilings.
As I walked through the patient rooms, two things struck me. First, the rooms were very comfortable – clean, modern, spacious, naturally lit and filled with flat panel televisions. Second, the hospital floors were… quiet. Yes, quiet. Imagine that… A quiet hospital experience.
Highlight #5 – Patient & Caregiver Education Collapses The Gap Between Reality & The Unknown
Similar to other top-ranked clinics, Cleveland Clinic extends significant resources to educate patients before, during and after surgery. However, the extent to which this team collapses the divide between reality and the potential unknown warrants praise.
- Consider that each patient receives a very thorough, very exhaustive reference binder prior to surgery.
- Consider that family members can participate in an educational course about cardiac surgery while their loved ones are having surgery.
- Consider that Cleveland Clinic provides all patients a ‘hotline’ to call in with questions after surgery.
- Consider that the surgeon meets with the patient’s family immediately following surgery — to discuss the operation.
- Consider that doctors and nurses are required to discuss the patient’s post-operative condition in front of the patient.
- Consider that patients are provided a ‘Medical Team Card’ that clearly indicates who will be helping them throughout their hospital stay (see below).
I could go on but I think you get the point. To some extent, I believe the Cleveland Clinic has developed and established patient-centric resources that provides answers before patients realize they have questions. In my opinion, that is great patient education.
Highlight #6 – The ‘Group Practice’ Model
During dinner, Dr. Eric Roselli, Dr. Douglas Johnston and Dr. Edward Soltesz helped me understand the ‘group practice’ model. As a group practice, physicians at Cleveland Clinic are full-time, salaried employees. This practice eliminates incentives to perform unnecessary tests or procedures and encourages physicians to consult with colleagues and spend the time necessary to practice excellent medicine.
“We are here to do right by the patient,” Dr. Roselli, staff surgeon, shared with me, “I am an employee just like the other members of our medical teams. Thanks to this model, we all work together to fight valvular disease and help our patients. It is a privilege for me to come to work every morning.”
Quick question… When was the last time someone told you it was a privilege to come to work?
According to Gina Cronin, Administrator of HVI, this model has proven advantageous for Cleveland Clinic and other centers that have adopted this approach. “In our opinion, we see the utility of this model as a definitive trend across our industry,” Gina explained to me.
Highlight #7 – The Actual Surgery Is Not The Epicenter Of The Patient Experience
As the tour came to a close, I felt as if my eyes had been opened to something more than a unique approach to cardiac care. I felt as if the Cleveland Clinic had transformed the traditional concept of cardiac surgery into an expansive experience defined more by the patient and less by the hospital.
Strangely, in my interpretation of the HVI platform, the surgical event is not the epicenter of that experience. Rather, just a piece of the puzzle that blends together with the other elements within HVI to heal your heart. 🙂
I would like to thank Dr. Lytle, Dr. Gillinov, Dr. Roselli, Dr. Johnston, Dr. Soltesz, Gina, Megan, Betsy, Paul, Michael, Michelle, Nichole, Shannon, Mary Joe and Katie for their time and help during this tour. While this was my first visit to HVI, I am hopeful it is not my last.
Keep on tickin!
Adam
Written by Adam Pick
- Patient & Website Founder
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Fran Zilko says on April 26th, 2012 at 3:20 pm |
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I agree with everything you saw and wrote, Adam. Dr. Gillinov performed my two valve procedure two years ago and I traveled from SW Florida for my surgery. The only new advantage that is now available is the Medical Team Card you pictured. That is a great addition to everything else that is done for the patients and their families (in my case, that was my husband and two daughters). The HVI is an awesome facility where patients truly do come first! |
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Richard Holoubek says on April 26th, 2012 at 4:18 pm |
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I am truly glad you were so impressed with the Cleveland Clinic, however, in the interest of fairness… I think you should give Massachusetts General, Presbyterian St. Lukes, Mayo Clinic etc. their just support as well. I had my aortic valve replaced at Massachusetts General and can honestly say that I was as impressed with my treatment before, during and after my surgery just as you were with the Cleveland Clinic. I think you should think about visiting each one of these more than qualified, care giving hospitals as well. I hope you give thought to my point in the interest of fairness to the many other fine facilities that perform miracle saving procedures everyday. |
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Linda Dixon says on April 26th, 2012 at 4:40 pm |
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Hi Adam, I knew you would be very, very, very, (how many did you say?) impressed with The Cleveland Clinic. I feel so fortunate and blessed to have been able to fly there from South Carolina for my aortic valve replacement in March. My experience could not have been any better. My surgery went perfectly (thank you Dr. Gillinov) and my care was extraordinary. Everything from the referral process to discharge just went perfectly. I was amazed at the people from all over the world who were there for heart surgery. I, of course, hope I never have to have OHS again, but if I do, I will fly to Cleveland again, in a “heartbeat”! |
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Rosanne Durell says on April 26th, 2012 at 4:51 pm |
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Please consider highlighting Rochester General Hospital in Rochester, NY; a satelite hospital of The Cleveland Clinic. This hospital was recently given the honor of being rated #1 in New York state and #3 in the nation for cardiac care. I had aortic valve replacement surgery there this past December under Dr. Ronald Kirshner and cannot speak highly enough of the care I received. If you would like a copy of a locally published health magazine which highlights RGH, Dr. Kirshner and his staff as a result of this rating, I would be happy to mail it to you. Sincerely, PS Adam, your book was incredibly helpful to read before my surgery – my cardiologist ordered a copy for his offfice. |
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Joan Davenport says on April 26th, 2012 at 4:57 pm |
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I am still trying to get a date for a visit to the Cleveland Clinic and have a consultation with Dr. Gillinov. From the first day that I learned that I need heart valve surgery, CC was my first choice. I started this journey in Feb. 2012 and I am no further along regarding CC than I was in Feb. I have since been able to meet with other surgeons on a consulting basis with no problem, but CC tells me I can meet with Dr. G. AFTER I go thru their pre-op procedures and tests. But what happens if at that point I don’t connect with him, feel at ease with him and surgery is the next morning?????? I need to see him and talk to him face to face and so far that does not seem like it’s a possibility. I called Dr. Gillinov’s nurse today and had to leave a message. I am asking for a date in June when I can come out to Cleveland and meet the doctor. Haven’t had a return call yet and based upon previous experience with CC, I’m not holding my breath.The whole world knows they are #1, but so far I’m not that impressed. |
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Fred says on April 26th, 2012 at 5:16 pm |
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Hi Adam, |
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Matt Miller says on April 26th, 2012 at 5:32 pm |
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I am an out of state patient. I had aortic valve repair last fall. It is an amazing place and I cannot recommend it highly enough. Another great thing you did not mention is the hotel/hospital experience. Having two great hotels right there is fantastically convenient. If you are having surgery and do not at least consult in Cleveland, you are not giving yourself all of your options. |
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Dr Jeff Pirofsky says on April 26th, 2012 at 5:44 pm |
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I had my valve surgery almost 2 years ago this August. One of the hardest decisions I had to make was “where to go?” With Adam’s help and being blessed with many choices I picked the CC and would do it again(hope I dont have to). Since that time I have had the pleasure and honor to help others with this most difficult decision and the answer is always the same….CC. Being a physician I was impressed how medicine should be practiced. The facility was beyond amazing….along with the staff from the nurses to Dr Gillinov who performed my procedure. |
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Matt Miller says on April 26th, 2012 at 5:55 pm |
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Joan Davenport: Dr. Gillinov is not the ony amazing surgeon there. I had Dr. Roselli and he was awesome. I have heard amazing comments about all of the doctors. I think if “Dr. G” is busy you might consider someone else. I think you’ll find the outcomes and experience are the same. |
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Dawn Cook says on April 26th, 2012 at 6:59 pm |
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Hi Adam, this is Dawn Cook. I had mitral valve repair/2xCABG with Dr. Gillinov in October last year – you called me right before! I happen to live a few miles down the street, but I would have traveled far and wide to have the experience I did at the Clinic. Dr. Gillinov was able to repair my very damaged mitral valve from Rheumatic Fever in childhood and truly it would have been replaced anywhere else. They also found a 99% blocked LAD artery 2 weeks before when I had no symptoms with a pre-op Cath. I told them I didn’t need it because I am 42 with no risk factors or symptoms, but he insisted. I would have died during surgery if they would not have know about it. I feel luck to have had the incredible experience I had – life is back to normal, I am running around, doing all the exercise I love, and feeling great! If you ever need a patient advocate for the Clinic – I am it! 🙂 |
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Curt Wagner says on April 26th, 2012 at 11:22 pm |
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Both my family and I would agree 100% with the CC assessment. Sept ’09 I/we traveled from South Florida and MN to have my bicuspid aortic valve repaired and we have only positive things to say. A special thank you to Dr Lars Svensson, one of the best aortic valve surgeons in the world!! I will also mention that the CC in Florida is very similar in patient experience and professionalism as well. Even though I was born and raised in MN and grew up thinking that the Mayo Clinic was second to none, after my/our CC experience, I will recommend them to anyone and everyone for heart issues, especially valve. Thanks for sharing Adam! |
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BillieUSA says on April 27th, 2012 at 6:32 am |
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My husband had a valve replacement in 2009 at the CC, and I want to publicize our thanks to the medical concierge Mary Ellen. We were in touch with her before our trip from Florida, but on the morning of our flight, my husband began to exhibit serious signs of a heart problem, and we called Mary Ellen again. She told him that he could go to a local ER, but if he decided to come to Ohio, she would have a limousine meet us at the airport and take him to the emergency room. My husband decided to make the trip, the limousine was on hand, and my husband went straight to the ER, where he began prep for his surgery. Thank you again, Mary Ellen. |
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Emilyrae Helfen says on April 27th, 2012 at 9:30 am |
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I have 3 DOCTOR heros at CCF. I had my open heart surgery (mitral valve repair) in July 2011. I did alot of research before I make a decision and it soon became clear that CCF was where I needed to go. The doctors there solved problems for me 3 different times. In Oct 2008 they fixed my A-fib that I had had for 10 years – I have been completely off all medicine and blood thiner ever since there. Then in Feb 2009 I went back to CCF to fix my pvc’s (I was having 32,000 a day) local doctors told me it could not be done because of adhesion from a VSD repair in 1984…. CCF fixed it – last monitor showed on 147 pvcs (normal) – DR. WALID SALIBA WAS MY HERO FOR THESE FIXES. I was aware that my mitral valve was leaking worse (mostly likely because of the previous problems that had now been fixed) Local drs saw no reason to fix it even though my pulmonary pressure was at 78 (normal is 35 and below) – Dr. Saliba picked up on this right away and referred me to Dr. Jaber (another hero) who got me an appointment with Dr. Marc Gillinov (my latest hero) He was able to repair my mitral valve instead of waiting for a replacement – It has been 9 months, and my last echo 2 days ago, showed my pulmonary pressure down to 40. Praise GOd and the excellent Doctors at CCF. |
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Brock Haussamen says on April 27th, 2012 at 12:28 pm |
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Adam, I appreciated your description of CC since I expect I will be going there at some point in the next few years. You’ve filled in many details about the good things I’ve heard and read about the hospital. The only concern that sticks in my mind is the flight back from Ohio to home in New Jersey. If the plane ride gets bumpy–which makes me nervous at the best of times–how will my recovering heart take it? But the Clinic itself sounds like a unique place to have the surgery itself. Thanks again. |
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Ruth Howell says on April 28th, 2012 at 1:46 pm |
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Sorry I missed you while you were at the Cleveland Clinic. I was there for my annual follow-up. I had a very complicated anterior leaflet mitral valve surgery there last April (Dr. Gillinov). Although I am sure you will eventually report on other heart hospitals, people should note that Cleveland Clinic has been the #1 heart hospital for the past 16 years!!!!! I think that says a lot and is why you were so impressed. As for the woman who is still trying to see Dr. Gillinov, may I recommend that she make an appointment to go through the appropriate channels (you must first see a staff cardiologist). That’s just the way it works. I did not meet Dr. Gillinov until the day before my surgery and I was okay with that because I had done all the research and really really wanted him as my surgeon. I have never heard from anyone that they didn’t like him. Just the opposite, he is a warm, caring, honest, humble and extremely talented man and heart surgeon. But the Clinic does have its own protocol and you need to follow it. That’s probably why the place runs so efficiently. FYI – there are many great cardiologists at CCF. Mine is Dr. Brian Griffin and I just adore him. I just returned from my annual follow up and all remains stable and my blood work has returned to normal and I am feeling great. |
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DVB says on May 3rd, 2012 at 7:56 pm |
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Hi Adam. Great piece! I like the list of ‘Highlights’. Not just what to look for when shopping for heart surgery, but applicable to our everyday jobs/lives too. There’s an unfolding story here, not just for CC, but at the high volume centers of excellence in general, and that is the trend toward zero operative mortality. When a center has hundreds of surgeries with zero mortality, that goes a long, long, way toward calming prospective patients. Calmer patients make better decisions and I’d guess have better long-term outcomes since they aren’t putting off what before seemed like a risky surgery. — DVB |
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John Hanner says on November 12th, 2013 at 4:38 pm |
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My uncle is from Ohio and found the heart center at the C.C a little impersonal and expensive. He had his valve replaced at the Ochsner Clinic in New Orleans and had a great outcome. The place is large but you can still talk to the department or section head. He also found it to be less expensive. |
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Ruth Howell says on November 12th, 2013 at 7:27 pm |
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Dr. Gillinov did my very complicated valve surgery 2.5 years ago. I had a lot of complicated issues and nearly died. Dr. Gillinov SAVED my life! I am certain that if I had not been at the Cleveland Clinic, I would surely have died. He is worth going to even if you never meet him. I didn’t meet him until the day before my surgery. Sometimes you just have to take a leap of faith. This is just how they work it at the Cleveland Clinic and it seems to be working fine. Now I call him or email whenever I have a question and he promptly returns my calls and emails (personally). When I go back for follow-up, he is always willing to see me for a hug and a hello. Not only is he one of the best heart valve surgeons in the country, he is a lovely, lovely, kind and caring man. I recall reading your post quite a while ago. So I guess you are not making progress in getting his office /the hospital to change its rules for you. I personally do not understand your hesitancy, especially reading all the rave reviews about him. If you cannot abide by their rules, I guess you can always go somewhere else. I WOULDN’T. But that’s always your choice. Good luck. Ruth Howell, Maine |
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Brock Haussamen says on November 13th, 2013 at 9:56 am |
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I had an aortic valve replacement at CC two months ago, with Dr. Sabik. Some points to add to the above: Dr. Sabik, in addition to replacing my valve, also removed the atrial appendage where blood can clot and create a stroke, and he did a pulmonary vein isolation in the atrium to reduce arrhythymia–both very tricky and helpful procedures, and neither of which I had asked for. Second, during the surgery, my wife was given a beeper that told her when the surgery was beginning, when it ended, and when she could meet Dr. Sabik to hear how it went–a very reassuring process for her. But I have a couple of suggestions for improvement for CC as well: For patients flying in from out of town, more discussion in the literature and from the staff about scheduling the return flight would be helpful. The only guideline given is that most patients leave after 5 to 7 days. I needed an extra day, the CC concierge was very helpful in changing the flight, but that sense of a “deadline” for leaving the hospital added some anxiety to my recovery and probably for some others as well. Second, it would have been good if someone had talked to me about bacterial endocarditis early on. This infection attacks a few biologic valve replacements over their lifetime, is on the rise, and can be deadly. No one spoke to me at all (not even my own cardiologist at home) about this. I first learned of it from a card given to me by CC to carry in my wallet, with lots of scary warnings. It was information i wish I had had before the surgery, not after, to better assess the risks. |
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Dr. Alfredo Trento is a heart valve expert having performed over 4,000 heart valve repair and replacement operations during his career.
